Bryn Mawr Classical Review 97.12.10

Reviewed by Rebecca Flemming, University College London,
ucraref@ucl.ac.uk.

Word Count: 1,206.

The essential connection between breath and life has been very
variously conceived and construed down the ages; but, within the
western tradition, the specific conception and construal of the
human body as a breathing body articulated in the late second
century A.D. by the physician Galen is of particular importance.
For his treatment of respiration is embedded in an oeuvre which
was proposed, and subsequently accepted, as a summation of classical
medical thinking. Its surviving substance stands, therefore, as
an incomplete but nonetheless imposing monument to both Galen's
own aspirations and achievements and those of his predecessors
and more immediate interlocutors, whose supersession has otherwise
left them largely speechless; and its substantial survival is
itself the mark of success, of that acceptance, of the dominance
of Galenic physiological and pathological models in medicine up
to, and even beyond, the European Enlightenment.

As Debru points out, historical studies of Galen's respiratory
notions have thus far tended to focus on their forward movement
rather than their background, or the fullness of their contemporary
setting. The concentration has been on the ways in which they
provided positive precursors for, or intractable impediments to,
the development of the modern understanding of the matter -- in
particular as this depends on William Harvey's discovery of the
circulation of the blood in the early seventeenth century -- and
not on the ways in which they work within Galen's medical system
as a whole, the ways in which they fit into the wider patterns
of his thought, and indeed, the deeper, precedent, patterns of
thought on the subject more generally. It is this imbalance that
Debru seeks to redress with this monograph.

Debru embarks, therefore, on her detailed descriptive and analytical
journey through Galen's theory of respiration with a few introductory
remarks about the persistence of the problem of breathing in his
work, and about some of the basic elements of the way in which
he approaches this problem -- conceptually, methodologically and
terminologically. Indeed it is Galen's linguistic attitude, as
evinced in his efforts to forge a more precise respiratory vocabulary
than that used by his predecessors -- to distinguish inspiration
and expiration both from each other and their sum, for instance -- that
receives the most attention here.

Issues of language remain prominent; but it is the matter of method -- and
of the interplay between empirical observation, even "experimental"
enquiry, and the exercise of reason along paths prescribed, or
simply proposed, by a pre-existing interpretative framework, in
particular -- that is the real focus of the extensive treatment
of the physiology and anatomy of breathing that follows. Debru
certainly gives the former priority as she describes the way in
which Galen rejected the cardio-centric respiratory models of
Aristotle and the Stoics to formulate a theory of breathing, or
at least of the mechanisms involved, in which the thoracic muscles,
and the nerves that govern them, play the central role: the lungs
expand and contract, air passes in and out, with the muscular
movements of the thorax wall, as directed by the nerves, not under
the direction of, or otherwise motivated by, the heart. In this
Debru sees Galen as building on some (but not all) of the insights
and ideas of the great Alexandrian anatomists, especially Erasistratus,
with his own programme of dissections, his own series of demonstrations.
Somewhat paradoxically it is in his delineation of the respiratory
organs themselves that Debru considers Galen to have been more
bound by a set of preconceptions about what constitutes an organ
and how they work. And, of course, the key question of why, on
account of what, humans breathe at all is both posed and answered
(answered, as Galen claims Hippocrates had before him, with reference
to the twin needs of nourishing the psychic pneuma and maintaining
the innate heat) within the frame of Galen's overall system of
understanding the human being in the cosmos rather than arising
directly from the bodies he delved into. Here too, however, Debru
is concerned to defend Galen's teleology from the charge that
it was a paralysing principle, a barrier to real progress; for
she sees the notion of the final cause as essentially heuristic,
as a way of making the practical and polemical problems confronting
the medical investigator and philosopher tractable, as a road
to a coherence that would otherwise have been damagingly lacking.

Internal relations within Galen's medical system then come to
the fore as Debru completes her coverage of his treatment of respiratory
issues with detailed discussions of human transpiration -- the permanent
passage of air and other substances through the skin -- and respiratory
diseases; showing how his thinking and therapies in these areas
fit in with principles and patterns already established. Lastly,
a wider, social, and more particularly religious, dimension appears
in her final chapter on respiratory exercises as part of various
kinds of regimen; for Debru provides the vocal gymnastics recommended
for general health as well as declamatory proficiency with a purificatory
background.

Debru's systematic approach to Galen's theory of respiration is
entirely laudable. The attempt to relate the various parts of
any individual conceptual complex within Galen's oeuvre both more
intimately to each other and more generally to the broader themes
of his thought, surely promises to be most productive in gaining
a real understanding of both Galenic specificities and generalities.
Moreover, since these themes clearly have a background, and a
contemporary context, they can provide a way into wider patterns
of medical and philosophical thinking about the human being. Such
an approach, however, poses considerable challenges in terms of
the organisation of argument and material; challenges which have
not really been met entirely satisfactorily in this case. Loosely,
Debru prefers to start with respiration itself, to break it down
into its parts and to follow them wherever they may lead within
Galen's thought world, rather than to begin by outlining the overall
shape and structure of that world itself, establishing the nature
of his vast literary project as a whole, and then methodically
setting about locating, pinning down, respiration within it. A
degree of clarity and coherence is, I feel, lost as a result;
and I suspect that less seasoned Galenic campaigners than myself
will particularly regret the relative slightness and selectivity
of the introductory chapter in this respect.

Much is achieved, however, in terms of analytic specifics, and
I found the discussion of Galen's teleology, and the emphasis
on its flexibility and dynamism, particularly useful. I was less
happy, though, with Debru's treatment of the other side of the
methodological and epistemological equation -- her assertion of
the unequivocal primacy for Galen of dissection and "experimentation",
of the direct examination and investigation of somatic phenomena,
over the application of reason, the force of established explanatory
grids -- for (quite apart from doubting the accuracy of speaking
of any kind of "experimental method" in antiquity),
I see Galen's observation and rationalisation as caught in a much
closer embrace, so close that the question of priority cannot
be resolved, indeed perhaps cannot even arise.

Nonetheless, I do hope that Debru's advocacy, both of Galen's
oeuvre as an incredibly rich and inviting subject of study from
any number of angles, and of one approach to it in particular,
will be heeded.